Early stage of vascular disease and diabetic kidney disease: an under-recognized entity

Classifying Kidney Disease in a Vervet Model Using Spatially Encoded Contrast-Enhanced Ultrasound Perfusion Parameters

Early stages of diabetic kidney disease (DKD) are difficult to diagnose in patients with type 2 diabetes. This work was aimed at identifying contrast-enhanced ultrasound (CEUS) perfusion parameters, a microcirculatory biomarker indicative of early DKD progression. CEUS kidney flash-replenishment data were acquired in control, insulin resistant and diabetic vervet monkeys (N = 16). By use of a mono-exponential model, time-intensity curve parameters related to blood volume (A), velocity (β) and flow rate (perfusion index [PI]) were extracted from 10 concentric kidney layers to study spatial perfusion patterns that could serve as strong indicators of disease. Mean squared error (MSE) was used to assess model performance. Features calculated from the perfusion parameters were inputs for the linear regression models to determine which features could distinguish between cohorts. The mono-exponential model performed well, with average MSEs (±standard deviation) of 0.0254 (±0.0210), 0.0321 (±0.0242) and 0.0287 (±0.0130) for the control, insulin resistant and diabetic cohorts, respectively. Perfusion index features, with blood pressure, were the best classifiers between cohorts (p < 0.05). CEUS has the potential to detect early microvascular changes, providing insight into disease-related structural changes in the kidney. The sensitivity of this technique should be explored further by assessing various stages of DKD.

Endothelial Dysfunction and 24-Hour Ambulatory Blood Pressure Monitoring in Patients with Diabetes

Arterial hypertension in patients with diabetes plays a main role in the earlier development of diabetic kidney disease (DKD), and endothelial dysfunction is considered to be a process involved in the development of diabetic complications. It is important to study the markers which gives the opportunity to identify DKD in early stage. In this article is presented a study of 24-hour Ambulatory Blood Pressure Monitoring (24hABPM) data in patients with diabetes and its interconnection with estimated glomerular filtration rate and endothelial dysfunction. The endothelial function was determined using the levels of TGF-b1(transforming growth factor-beta1) and VCAM-1 (vascular cell adhesion molecule-1). In our study, we obtained convincing results that complex including endothelial dysfunction and results of 24hABPM can be considered as early signs of DKD progression in patients with diabetes.